[Hiring] Utilization Management Nurse Consultant @CVS Health

Role Description

We are seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote Precertification Nurse role.

• Review clinical information and authorization requests using evidence-based guidelines and established criteria
• Collaborate with healthcare providers to gather necessary documentation
• Approve services within scope or refer complex cases to a Medical Director
• Manage a high volume of cases in a fast-paced, phone and computer-based environment

Qualifications

• Active, unrestricted COMPACT RN license in your state of residence
• 3+ years of clinical nursing experience
• Strong computer skills with the ability to navigate multiple systems
• Ability to work Monday-Friday, 8:00 AM-5:00 PM, with occasional weekend/holiday on-call coverage
• Associate's degree in Nursing required

Requirements

• Prior authorization or utilization management experience (preferred)
• Compact RN license (preferred)
• BSN (preferred)

Benefits

• 100% remote opportunity – preference for those residing in Virginia
• Make a clinical impact while enjoying a consistent schedule
• Utilize your nursing expertise in a non-bedside role
• Collaborative, mission-driven healthcare environment
• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility

Work from Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer with a minimum download speed of 25 mbs download and 3 mbs upload (WiFi and satellite internet are not permitted)
• A quiet, secure and private designated home virtual work location, compliant with CVS Health and HIPAA guidelines
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live
• The company will provide equipment (keyboard, monitor, computer, headset, etc.)
• New hires should provide their own workspace furniture (desk or standing desk)
• Commit to obtaining required internet speeds and adhere to all Work From Home requirements

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
• Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace)
• Ability to log in to secure systems (e.g., VPN, EHR portal), manage strong passwords, and recognize suspicious emails or links
• Ability to resolve common technical issues independently
• Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $29.10 - $62.32. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.